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![Page 1: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/1.jpg)
This document was prepared by Residential Care Services for the Locator website.
![Page 2: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/2.jpg)
Residential Care Services Investigation Summary Report
Provider/Facility: ELENAS HOME AT LAKE ROAD(689324)
Intake ID(s): 3653070
License/Cert. #: AF752149Investigator: Webb, Katherine Region/Unit: RCS Region 2/Unit B Investigation
Date(s):07/05/201908/14/2019
through
Complainant Contact Date(s): 07/05/2019, 07/26/2019, 08/14/2019Allegations:1: The named resident was left behind closed doors and the staff were not patient with residents with dementia. The staff pushand pull the named resident around.
Investigation Methods:Sample: 6 Residents. Observations: Tour of
facility/environment; 6residents in their roomsin bed; staff andresidents and theirinteractions with eachother. Two caregiverswhose primary languagewas not English.
Interviews: Named Resident;Residents; Facility Staff;Provider; Others notassociated with facility.
Record Reviews: Resident recordsincluding assessments,care plans; Staff recordsincluding orientation andtraining. Issues of staffrecords are being dealtwith on concurrent FullInspection.
Allegation Summary:1: The named resident who had become bed bound sometime during May 2019, was observed in his bed, however his room doorwas observed to be open. The named resident did not express concerns related to his door or treatment by the staff.
Page 1 of 2This document was prepared by Residential Care Services for the Locator website.
![Page 3: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/3.jpg)
Residential Care Services Investigation Summary Report
Unalleged Violation(s):1: The named resident's negotiated care plan was not signed.2: The named resident did not have an updated assessment following a change of condition.3: The named resident did not have an updated negotiated care plan following a change of condition.
Yes No
Conclusion /Action:
Failed Provider Practice Identified /Citation(s) Written
Failed Provider Practice Not Identified /No Citation Written
CONSULT388-76-10375 Negotiated care plan Signatures Required. (1)(2) requires signatures of Resident and AFH.CITATIONS388-76-10350 Assessment Updates required. (1)(2) requires update of the assessment when there is a significant change andwhen the negotiated care plan no longer reflects the residents current needs.388-76-10380 Negotiated care plan Timing of reviews and revisions.(2) requires the NCP to be updated when parts of the planno longer address the residents needs.
Page 2 of 2This document was prepared by Residential Care Services for the Locator website.
![Page 4: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/4.jpg)
This document was prepared by Residential Care Services for the Locator website.
![Page 5: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/5.jpg)
This document was prepared by Residential Care Services for the Locator website.
![Page 6: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/6.jpg)
This document was prepared by Residential Care Services for the Locator website.
![Page 7: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/7.jpg)
This document was prepared by Residential Care Services for the Locator website.
![Page 8: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/8.jpg)
This document was prepared by Residential Care Services for the Locator website.
![Page 9: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/9.jpg)
This document was prepared by Residential Care Services for the Locator website.
![Page 10: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/10.jpg)
This document was prepared by Residential Care Services for the Locator website.
![Page 11: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/11.jpg)
This document was prepared by Residential Care Services for the Locator website.
![Page 12: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/12.jpg)
This document was prepared by Residential Care Services for the Locator website.
![Page 13: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/13.jpg)
This document was prepared by Residential Care Services for the Locator website.
![Page 14: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/14.jpg)
This document was prepared by Residential Care Services for the Locator website.
![Page 15: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Unalleged Violation(s): 1: The named resident's negotiated care plan was not signed. 2: The named resident did not have an updated](https://reader035.pdfslide.us/reader035/viewer/2022070916/5fb70334b6f20b3f68740155/html5/thumbnails/15.jpg)
This document was prepared by Residential Care Services for the Locator website.
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